Corresponding (İletişim): Bahtışen Kartal, Tokat Gaziosmanpaşa Üniversitesi Sağlık Bilimleri Fakültesi, Hemşirelik Bölümü, Kadın Sağlığı ve Hastalıkları Hemşireliği Anabilim Dalı, Tokat, Turkey
E-mail (E-posta): bahtisen.kartal@gop.edu.tr
Received (Geliş Tarihi): 24.07.2018 Accepted (Kabul Tarihi): 08.10.2018
DOI: 10.16899/gopctd.447159 J Contemp Med 2018;8(4):356-360
Original Article / Orjinal Araştırma
Investigation of body perception in pregnant women
according to physical changes in pregnancy
Gebe kadınlarda beden algısının gebelikte meydana gelen
fiziksel değişikliklere göre incelenmesi
Bahtışen Kartal,1 Aynur Kızılırmak,2 Ayşegül Zedelenmez,3 Ebru Erdem4 1Department of Nursing, Tokat Gaziosmanpaşa University Health Science Faculty, Tokat, Turkey
2Nevşehir Hacı Bektaş Veli University Semra and Vefa Küçük Health College, Nevşehir, Turkey 3Dialysis Program, Cappadocia University, Nevşehir, Turkey
4Department of Nursing, Niğde Public Hospital, Niğde, Turkey
B
ody perception is a comprehensive concept that includedin perceptions, attitudes, thinking, belief, feelings and
be-haviors of person about his/her body.[1] Body perception has
been defined as an individual's internal representation of his
or her own outer appearance.[2,3] This situation that could
eval-uated as attachment of person with his/her own body can be
both positive or negative.[4]
Body dissatisfaction is common in the general population,
Introduction: The aim of this study was to investigate the body
perception in pregnant women according to physical changes oc-curring during pregnancy.
Methods: This study was conducted with the pregnant women
who applied to polyclinic of a government hospital at a city which in the middle of Turkey, as descriptive. Study was conducted with 300 pregnant women. Data were collected by using an Informative Form and Body Perception Questionnaire. Data were evaluated by using percentage, mean, One-Sample Kolmogorov-Smirnov, Inde-pendent Samples Test and One-way Anova importance tests with Pearson correlation.
Results: Pregnancy mask, abdominal striae, edema, body
percep-tion scores were higher in pregnant women and it was significant as statistically (p<0.05). Body perception scores were found to be higher in pregnant women with low income and those with health problems in pregnancy (p<0.05). In addition, body perception scores increased as the age increased [r(300)=0.166; p p<0.01].
Discussion and Conclusion: As a result, body perception scores
of women, who experienced some physical changes during preg-nancy, increased.
Keywords: Body perception; physical change; pregnancy.
Amaç: Çalışmada; gebe kadınlarda beden algısının gebelikte meyda-na gelen fiziksel değişiklere göre incelenmesini amaçlanmıştır. Gereç ve Yöntem: Çalışma Türkiye’nin iç bölgesinde bulunan bir ildeki devlet hastanesinin gebe polikliniğine başvuran gebelerle yürütülmüş olup tanımlayıcı tiptedir. Çalışmanın örneklemini 300 gebe oluştur-muştur. Araştırmanın verileri araştırmacılar tarafından geliştirilen bir bilgi formu ve ‘vücut algısı’ ölçeği kullanılarak toplanmıştır. Verilerin değerlendirilmesinde sayı, yüzde, ortalama, One-Sample Kolmogo-rov-Smirnov, Independent Samples t Test One-way anova ve Pearson correlation tesleri kullanılmıştır.
Bulgular: Gebelik maskesi, karında stria, ödem olan gebelerde beden algısı skorları daha yüksek bulunmuştur ve bu istatistiksel olarak an-lamlıdır (p<0.05). Düşük gelir durumuna sahip olan gebelerde ve ge-beliğinde sağlık problemi yaşayanlarda beden algısı skorlarının daha yüksek olduğu belirlenmiştir (p<0.05). Ayrıca yaş arttıkça beden algısı skorlarının arttığı belirlenmiştir[r (300)=0.166; p p<0.01].
Sonuç: Sonuç olarak, gebelikte bazı fiziksel değişiklikler yaşayan kadın-ların beden algısı skorları artmıştır.
Anahtar Sözcükler: Beden algısı; fiziksel değişiklikler; gebelik.
Özet Abstract
and appears to be more prevalent among women than men.
[5] A meta-analysis found that males are more satisfied with
their bodies than females.[6] High levels of body dissatisfaction
are primarily attributed to the existence of social pressures
re-garding thinness and body shape.[7,8]
Noonan (1981) suggested that a physical or psychologic change could cause a change at body perception; some phys-ical changes as puberty, elderliness, pregnancy and delivery
could disturb the body perception.[9,10] Besides, important
changes at body as pregnancy, also, could affect body
percep-tion.[5]
In pregnancy, a woman’s body undergoes rapid physical changes in many ways, but most notably in weight and shape.
[11] Pregnancy is characterized by significant physiognomic
and psychosocial changes, such as hormonal fluctuations, the experience of pregnancy related physical symptoms and changes to one’s appearance (e.g., rapid weight gain, nausea, back ache, varicose veins, stretch marks, acne and swollen ankles and feet) and changing relationship dynamics with
partner, family, and friends.[5] The physical changes at
preg-nancy especially exhibit with second trimester. The changes in weight and shape of body are characterized by waist’s
get-ting thick, growth in abdomen and breast enhancement.[12]
Increased pigmentation, pregnancy mask, striae gravidarum,
hirsutism, changes in vascular structure and nails are the other
changes that occurred at pregnancy.[13,14]
While the most of these physical changes in pregnancy were thought as normal for some women, some women can feel themselves as different, awkward, clumsy, blaze, ugly and
unattractive.[14–16] These physical changes are Cash more
ap-parent in time and could affect the body perception.[17] As a
result, self-confidence and self-respect can decrease,[15,16]
de-pression symptoms can occur.[17,18]
The aim of this study was to investigate the body perception in pregnant women according to physical changes occurring during pregnancy.
Materials and Method
This study was conducted with the pregnant women who ap-plied to polyclinic of a government hospital at a city which in the middle of Turkey, as descriptive. In the study, simple ran-domized sample method was used. Volunteering was based on for participating. The subjects were 300 pregnant. Data was collected by using face to face technique after taking written consent from institute. Also, verbal consent was taken from the participants by informing about study.
Tools
Data was collected by Informative Form that was improved by the researchers and Body Perception Questionnaire.
Informative From
This form was prepared by the researcher in order to deter-mine sociodemographic and pregnancy characteristics of women.
Body Perception Questionnaire [BPQ]
This questionnaire that was improved by Secord and Jourard [1953] aimed to measure how much people pleased with their various body parts and functions. The reliability and va-lidity were conducted by Hovardaoğlu [1993] in our country.
[19] There are 40 items in questionnaire. High score shows not
being pleased. The Cronbach’s Alpha reliability score was 0.75 in this study.
Statistical Analysis
Data were evaluated by using percentage and mean tests. Homogenity was investigated by One-Sample Kolmogorov-Smirnov Test (sig. 0.20) and when it was higher than 0.05, it is accepted as normal distribution and so Independent Samples Test and One-way Anova importance tests with Pearson cor-relation test were used.
Results
There are socio-demographic characteristics of pregnant women at Table 1. It was determined that the average age of the women was 26.9±5.6, 91.3% didn't work, 27.3% graduated
Table 1. Sociodemographic and obstetric characteristics of pregnant women Characteristics n % Age (X±SD) 26.9 ± 5.6 Working statute Worked 274 91.3 Not worked 26 8.7 Educational statute Literate 34 11.3 Primary school 82 27.3 Secondary school 62 20.7 High school 75 25.0 College/faculty 47 15.7 Income monthly
Low income from expense 116 38.7 Equal income to expense 164 54.6 More income from expense 20 6.7 Number of pregnancy 1 80 27.0 2 115 38.3 3 74 24.7 4 and over 30 10.0 Trimester 1th trimester 52 17.3 2th trimester 116 38.7 3th trimester 132 44.0 SD: Standard deviation.
from primary school, 54.6% had equal income to expense, 38.3% were in their second pregnancy. Also, 44.0% of the pregnant women were at their third trimester.
Besides, it was found that of the women; 18.0% had pregnancy mask, 33.0% had got striae on her breast, 48.8% had striae gravidarum, 22% had got varicose, 26.6% had edema. Again, 35% of the pregnant women hadn’t any health problems in their pregnancies and 34.3% of these were nausea-vomiting. There are the body perception mean scores according to phys-ical changes in pregnancy in Table 2. Pregnant women with pregnancy mask, striae gravidarum and edema were found to have a high score and it was significant as statistically (p<0.05). The body perception scores according to some variables are seen in Table 3. Body perception scores were found to be higher in pregnant women with low income and those with health problems in pregnancy (p<0.05). In addition, as the number of pregnancies and trimesters increased, body per-ception scores increased in pregnant women but this increase was not statistically significant (p>0.05).
When the relationship between age and body perception scores was investigated, it was found that the body perception score increased as the age increased [r[300]=0.166; pp<0.01].
Discussion
Because of the effect of estrogen and progesterone level of melanocyte stimuli hormone gets higher and increasing of pigmentation starts in the second month of pregnancy. Pig-mentation areas are mostly forehead, bucca and nasal bone.
This change in face is called as pregnancy mask.[14,20,21]
Also, abdominal wall is stretched and it gets thinner with a glazy appearance. In some areas, there are splits. These splits that can be seen around breast and hips occur because of lac-eration by stretching of skin and losing elasticity of adipose tissue. These splits are called as striae or linea gravidarum
mostly occur after 6th gestational month.[14,21] In our study,
the pregnant women had got striae on their breast (33.0%) and abdomen (48.8%). These physical changes that are seen in pregnancy can cause that their feeling themselves as dif-ferent, awkward, clumsy, blaze, ugly and unattractive. As a result of these changes, self-confidence and self-respect of them can decrease and body perception can be affected as
negatively.[15,16] In the study, pregnant women with pregnancy
mask, striae gravidarum and edema were found to have high scores (p<0.05). Also, it was determined that with increased pregnancy month, the body perception scores increased and it was thought that the cause is that the changes that oc-curred in pregnancy (striae, edema) were more apparent with increased pregnancy month.
One of the changes in pregnancy is varicose. No difference was determined between the body perception scores of
Table 2. Body perception scores according to physical changes in pregnancy
Physical changes Body Perception Scores
n X±SD p Pregnancy mask Yes 54 119.9±35.0 0.001 No 244 101.8±29.1 Striae on breast Yes 99 110.1±33.1 0.057 No 199 102.6±29.7 Striae gravidarum Yes 146 110.3±32.2 0.004 No 152 100.0±29.1 Varicose Yes 66 105.0±33.8 0.987 No 232 105.1±30.2 Edema Yes 80 111.5±31.4 0.034 No 218 102.7±30.6 SD: Standard deviation.
Table 3. Body perception scores according to some variables
Variables Body perception scores
n X±SD p Occupation Worked 272 105.1±31.4 0.993 Not worked 26 105.0±27.3 Economic status Low income 115 110.2±32.3 Middle income 164 102.7±30.3 0.039 High income 19 94.1±24.1 Educational statute Literate 34 113.0±34.6 Primary school 81 106.2±27.7 Secondary school 61 98.4±31.1 0.16 High school 75 108.1±30.7 College/faculty 47 101.5±33.3 Number of pregnancy 1 79 98.5±27.8 2 115 106.9±31.4 0.171 3 74 108.5±31.0 4 and over 30 107.0±36.0 Trimester 1th trimester 51 100.6±30.3 2th trimester 115 105.4±29.6 0.50 3th trimester 132 106.6±32.5
Health problem in pregnancy
Lived 105 110.1±30.3
0.04
Not lived 195 102.4±31.2
women in terms of having varicose veins or not. In the region that the study was conducted, because of the wearing style of the women, their varicose veins aren’t apparent. So, the body perception scores may not be affected.
Body size dissatisfaction is affected by socio-economic
fac-tors.[22] In this study, the body perception scores were found to
be higher in pregnant women with low income (p<0.05). The results of the study of Babacan Gümüş and friends are similar to our study in terms of relationship between low income and
the body perception.[16] However in the study of Kumcağız and
friends, the pregnant women with high socioeconomic level
had negative body perception.[23]
Body perception is constituted of a combination the efforts of person about what her real body, what she wants and what she wants to change with their experiences. Body perception can be an important reason of anxiety before and after preg-nancy. Pregnant women feel themselves as unattractive
es-pecially between 27th and 32nd gestational age. This situation
can affect their self- confidence.[23] In terms of changes in body
perception as women progress through pregnancy, findings
have been inconsistent.[24] At 17 weeks the nulliparous woman
is experiencing major body changes for the first time and thus feels a much greater level of dissatisfaction with the
ap-pearance of the body.[15] For the most part women reported
adapting to the changes that occurred in their body; however, women were most likely to experience higher levels of body
dissatisfaction in early to mid-second trimester.[24] In our study,
it was determined that with increased gestational month, body perception scores increased but the difference between groups was not significant. Our study is similar to literature. Besides, with increased age body perception score increased [r[300]=0.166; p p<0.01]. In the study of Kumcağız and friends, a negative correlation between age and body perception of the pregnant women was found, younger women had more higher
body perception score than the others (r=-0.305, p=0.001).[23]
In the study, it was found that the body perception scores of women who experienced 2 or more pregnancies were higher than the body perception scores of women who experienced only one pregnancy but there wasn’t any significant differ-ence between groups. Also, the results of Babacan and friends are similar to our study that with increased number of
preg-nancy, their dissatisfaction also increased.[16] In another study,
there was a negative correlation between number of preg-nancy and body perception, the pregnant women who had less number of pregnancy had got higher body perception
than the others.[23]
Conclusions
It was determined that body perception scores were found to be higher in pregnant women with pregnancy mask, striae gravidarum, edema, low income, age and living health prob-lem in pregnancy. The physical changes in pregnancy and health problems could cause the changes in body perception in pregnant women.
Conflict of interest: No conflict of interest has been declared by
the authors.
References
1. Cash TF. Body perception: past, present, and future. Body percep-tion 2004;1:1-5. http://www.ufjf.br/labesc/files/2012/03/Body-I-mage_2004_Body-Image-past-present-and-future.pdf
2. Slade PD. What is body perception? Behav Res Ther 1994;32(5):497-502. https://www.ncbi.nlm.nih.gov/pubmed/8042960
3. Gjerdingen D, Fontaine P, Crow S, McGovern P, Center B, Miner M. Predictors of mothers’ postpartum body dissatisfaction. Women Health 2009; 49(6):491–504. https://www.ncbi.nlm.nih.gov/ pubmed/20013517
4. Dogan T, Sapmaz F, Totan T. Beden İmgesi Baş Etme Stratejileri Ölçeğinin Türkçe uyarlaması: Geçerlilik ve güvenilirlik çalışması, Anadolu Psikiyatri Dergisi 2011;12:121-129. http://toad.edam. com.tr/sites/default/files/pdf/beden-imgesi-bas-etme-strateji-leri-olcegi-toad.pdf
5. Fuller TM, Skouteris H, Watson B, Hill B. Body perception dur-ingpregnancy: an evaluation of thesuitability of the body atti-tudes questionnaire. Biomed Central Pregnancy and Childbirth 2012;12:91. http://bmcpregnancychildbirth.biomedcentral.com/ articles/10.1186/1471-2393-12-91
6. Feingold A, Mazzella R. Gender Differences in body perception areincreasing. Psychological Science 1998;9(3):190-195. http:// journals. sagepub.com/doi/abs/10.1111/1467-9280.00036 7. Loth KA, Bauera WK, Wall M, Berge J, Neumark-Sztainer D. Body
satisfaction during pregnancy. NIH Public Access 2011;8:297– 300. https://www.ncbi.nlm.nih.gov/pubmed/21561821
8. Holsen I, Carlson Jones D, Skoqbrott Birkeland M. Body percep-tion satisfacpercep-tion among Norwegiana dolescents and young adults: A longitudinal study of the influence of interpersonal rela-tionships and BMI. Body perception 2012;9:20–208. https://www. ncbi.nlm.nih.gov/pubmed/22391409
9. Noonan KA. Coping with illness. Delmar Publication Inc. Newyork. 1981. pp.145-147.
10. Öz F. Sağlık Alanında Temel Kavramlar 2. Baskı, Ankara, Mattek Baskı 2010.
11. Tiggeman M. Body perception across the adult life span: stabil-ity and change. Body perception 2004;1:29-41. http://www.sci-encedirect.com/science/article/pii/S1740144503000020
12. Murray I, Hassall J. Changeand Adaptation in pregnancy. In D.M. Fraser & M.A. Cooper (Eds.), Myles Text Book For Midwives. Toronto. 2009.pp:216.
13. Durmazlar SPK, Atacan D, Eskioglu, F. Gebelikde Fizyolojik ve Biyolojik Deri değişiklikleri: Derleme, Kadın Doğum Dergisi 2007;6(1):1331–1334. http://www.journalagent.com/goj/pdfs/ GOJ_6_1_1287_1356.pdf
14. Taşkın, L. Doğum ve Kadın Sağlığı Hemşireliği. (13rd ed.). Sistem
Ofset Matbaacılık Ankara. 2016.
15. Goodwin A, Astbury J, McMeeken J. Body perception andpsy-chosocialwell-being in pregnancy: A comparisonexercisers, andnon-exercisers. Aus N Z J Obstet Gynecol 2000;40(4):442-7. https://www.ncbi.nlm.nih.gov/pubmed/11194433
Ge-belikte Benlik Saygısı ve Beden İmajı ile ilişkili özellikler, Anatol J ClinInvestig2011;5(1):7-14. http://citeweb.info/20112846835 17. Skouteris H. Body perception Issues in Obstetrics and
Gynecol-ogy. In T.F. Cash & L. Smolak (Eds.), Body perception, A Handbook of Science, Practice, and Prevention 2011 (pp. 364-371). New York: E-Publishing.
18. Clark A, Skouteris H, Wertheim S, Paxton S, Milgrom J. The rela-tionship between depression and body dissatisfaction across pregnancy and the postpartum: A prospective study. Journal of Health Psychology 2009;14:23–31. https://www.ncbi.nlm.nih. gov/pubmed/19129334
19. Hovardaoğlu S. Body Perception ScaleIn. Turkish. Psikiyatri, Psikoloji, Psikofarmakoloji Dergisi 1993;1(1):26.
20. Murray SS, McKinney ES. Foundation of maternal-Newbornand Women’s Health Nursing (5rd ed.). United States of America. 2010.
21. Taşpınar A. Normal Gebelik. In A. Şirin & O. Kavlak (Eds.), Kadın Sağlığı, İstanbul. 2008.pp.454-45.
22. Bagheri M, Dorosty A, Sadrzadeh YH, Eshraghian M, Amiri E, Khamoush CN. Pre-pregnancy body size dissatisfaction and ex-cessive gestational weight gain. Maternaland Child Health Jour-nal 2013:17(4):699-707. https://www.ncbi.nlm.nih.gov/pubmed/ 22722914
23. Kumcagız H. Gebe Kadınlarda Beden Algısı ve Benlik Saygısının Bazı Değişkenlere Göre İncelenmesi, Journal of Human Sciences 2012; 9(2): 691. https://www.j-humansciences.com/ojs/index. php/IJHS/article/view/1536/945
24. Skouteris H, Carr R, Wertheim EH, Paxton SJ, Duncombe D. A prospective study of factors that lead to body dissatisfaction dur-ing pregnancy. Body perception 2005;2:347–361. https://www. ncbi.nlm.nih.gov/pubmed/18089200
